Chevron

Chevron’s Health and Medical Services’ (H&MS) strategic intent is to provide services that promote a healthy and productive workforce.  An integrated approach between an interdisciplinary staff of health professionals insures that employees’ mental and physical needs are addressed.  Services support Chevron’s strategic intent to be “the industry leader in safety and health performance”.   Management customers pay for worksite services, which insures those services meet their needs.

Chevron’s employee base is 70% male, aging (average age = 47), and averages 18 years of service.  Approximately 60% of the workforce is employed in blue collar jobs which range from refineries, to offshore production platforms, to chemical plants. While domestic operations exist throughout the US, employees are concentrated on the Gulf Coast and in California.

Because Chevron is highly decentralized, programs and services vary by operating company and location.   Depending on need and management support, programs can range from awareness to in-depth one-on-one behavior change.  Almost all Chevron sites of 1,000 employees or more provide staffed Health Quest fitness centers (9 total)with health promotion programs.  Employees, retirees, and their dependents pay dues, and membership ranges from 35% to 45% of eligible employees.

Despite decentralization, overall H & MS goals for health and productivity create a structure within which to operate:

1. Reduce health risks
2. Reduce absenteeism
3. Reduce on and off the job injuries
4. Reduce costs.

The stages of change model is used for individual behavior change and individual accountability is nurtured and expected.   However, we feel strongly that an individual approach is not sufficient.  The emphasis on health improvement is equally focused on the organization / work culture and the work environment.   Most health promotion programs are delivered on Company time in support of a work group or business unit’s specific needs.  Thus participation rates are very high, often exceeding 70%.

H& MS is also closely aligned with our Benefits Planning & Design group.  Two of five health and welfare strategies focus specifically on promoting a healthy and productive workforce and encouraging participant accountability to become wise consumers.  We are closely involved in management of Chevron’s 70+ health plans and mental health plan.  Demand management is addressed primarily through our health plans, and has included self-care (with a worksite component), diabetes, and asthma management programs.

Chevron’s medical costs virtually remained flat between 1991 and 1997, for an overall increase of less than 1%.  Occupational incident rates decreased by 50%, and occupational incident rates with lost time decreased by 60%.  A rigorous, quasi experimental study conducted on the Health Quest fitness centers by an outside, objective evaluator demonstrated cost savings through reduction in medical expenditures and lost work days.  Alcohol use and smoking have steadily declined since 1991.

Health Quest Fitness Center Study

The Health Quest Fitness Center Study demonstrated cost savings to Chevron through a reduction in medical (inpatient, drug and mental health) expenditures for employees who participated two or more times per week in the program.  The results of the study revealed that fitness center participation has a beneficial effect on medical expenditures: as participation increased, medical expenditures decreased.  Regular participants  experienced 37% lower inpatient and drug expenditures than non-participants over a two and one half year period.  After adjusting for confounding variables, regular participants experienced inpatient and drug expenditures at $827, compared to $1,309 for non-participants (p = .03).  This study has been accepted for publication in the June, 1998 issue of the Journal of Occupational and Environmental Medicine.  A second study, on the same population and using the same methodologies, demonstrated a reduction in lost work days associated with regular participation.  Regular participants, on average, experienced 54% fewer lost work days than non-participants.

Smoking Cessation

Smoking rates dropped 35%, from 28% in 1991 to18% in 1998, as measured by health risk appraisals administered through Staywell.  This exceeds the Healthy People 2000 goal for blue-collar workers (20%), and is close to meeting the overall goal of 15% for adults.  A description of this smoking cessation program and innovative work done with health plans and an employer cooperative are published in Tobacco Control, 1997 (the proceedings of the AHCPR Smoking Cessation Guideline).

Alcohol Reduction

Alcohol use has decreased by 29% since 1991 (Staywell HRA).  Recovery rates for drug and alcohol addiction are 70% two years after treatment completion. Abstinence is measured by a two year period of regular drug and alcohol testing.   “Success” from substance abuse problems is defined as remaining employed without further problems.

• Chevron - Healthquest

The Healthquest fitness centers, smoking cessation programs and alcohol reduction programs have resulted in medical costs remaining virtually flat between 1991 and 1997 for an overall increase of less than one percent.  Occupational incident rates decreased by 50% and occupational incident rates with lost time decreased by 60%.  A rigorous, quasi-experimental study conducted on the Healthquest fitness centers by an outside objective evaluator demonstrated cost-savings through reduction in medical expenditures and lost workdays.  Alcohol use and smoking have steadily declined since 1991.

Specific Comments Included: The program has HRA data on two-thirds of the population.  High participation overall in the program occurs in spite of a decentralized model.   Chevron is considering an overall company health metric.  There are nine fitness centers which allow participation on company time.   The program has been developed by consensus.  The program is based on stages of change coupled with organizational change theories and focuses on both individual and systems level changes.  Results accepted for publication in The Journal of Occupational and Environmental Medicine.  Dose response effects have been established with the fitness facility.  The program has strong leadership.  The emphasis on occupational safety is a plus.

Reservations Included: The bonus tied to safety performance raises questions about integrity of accident reporting.  How was the HRA data used?  Secular effects over the 1991-1997 period cannot be entirely ruled out.  It is unclear how intense the intervention is at sites which do not include fitness centers.